Brain Tumours (Clinical) Flashcards
What are the common types of primary brain tumour?
- glioma of the neuroepithelial tissue
- Meningioma
- Pituitary adenoma
What are the most common cancers that metastasize to the brain? (secondary brain tumours)
- Renal cell carcinoma
- Lung carcinoma
- Breast carcinoma
- Malignant melanoma
- GI tract malignancy
Are primary or secondary brain tumours more common?
Secondary
>100,000/year in US vs 17,000 primary
What CNS cells are gliomas derived from? How are gliomas graded by the WHO?
- Derived from astrocytes / ependymal cells / oligodendrocytes
- Graded I-IV by WHO
What is the most common type of glioma? What grade is it? How does it tend to progress?
- Glioblastoma Multiforme (GBM)
(glioblastoma multiforme is a grade 4 astrocytoma) - Grade IV
- Aggressive tumour, but doesn’t tend to spread systemically
Characteristics of meningiomas? Location/progression/layer of meninges
- Slow growing, usually benign. Usually cured if completely removed
- Usually located along flax cerebri, convexity or sphenoid
- Arise from arachnoid
Characteristic of pituitary tumours? Most common type/specific presentation
- Adenoma most common, only 1% tumours malignant
- Present with visual disturbance and hormone imbalance
Common clinical presentation of intracranial tumours?
- Raised ICP effects
- Focal neurological deficit
- Epileptic fits
- CSF obstruction
Symptoms of raised ICP?
- Headache
- Nausea / vomiting
- Visual disturbances (DV / diplopia)
- Somnolence (sleepiness)
- Cognitive impairment
- Altered consciousness
Clinical signs of raised ICP?
- Papilloedema
- 6th nerve palsy (eye adducted)
- Cognitive impairment
- Altered consciousness
- 3rd nerve palsy
What type of tumours are likely to cause hydrocephalus?
- Tumours in or close to CSF pathways
- Especially in posterior fossa & in children
Investigations when suspected brain tumour?
- CT & MRI scans
- PET scan
- Think of secondary sources (eg. CXR)
- Biopsy
What is papilloedema and how does it appear on fundoscopy?
- Swelling of optic disc due to raised ICP
- Optic disc margins blurred on fundoscopy
+/- engorged veins / reduced pulsation
What are some focal neurological deficits encountered with brain tumours / raised ICP?
- Hemiparesis (weakness of one side of body)
- Dysphasia
- Hemianopia
- Cognitive impairment (memory / direction etc.)
- Cranial nerve palsy
- Endocrine disorders
What is ataxia?
Term to describe disorders that affect speech, coordination and balance
Go over this lecture it’s got some good scenarios for exam practice
horny
What types of tumours might cause epileptic fits?
Epilepsy only caused by lesions above the tentorium cerebelli
What can be an important step after excising a tumour from the brain?
- Tissue biopsy
Indicates whether it’s a metastases or primary
Treatment of brain tumours?
- Surgery
- Radio/chemo therapy
other:
- Epilepsy treatment
- hormone / endocrine therapy
- Analgesics
How does glioblastoma multiforme tend to respond to treatment?
- Complete surgical excision tends to be impossible
Biopsy/debulk only
What is the prognosis for the different types of intracranial cancer?
- Meningioma: commonly cured by surgery, anticonvulsants
- Astrocytomas: low grade - long life expectancy, high grade / GBM - avg. 1 year survival
- Metastases: frequently good but depends
Should you do a lumbar puncture when there are signs suggesting an intracranial mass lesion? Why?
- Definitely not
- Raised ICP due to the mass means CSF will rush out of the puncture hole if the hole is made
